Creating a Medical Home

Creating a Medical Home

The Role of the Pediatric Medical Home

Given the number of children and adolescents exposed to violence and the potential for long-lasting impact on physical health, pediatricians should routinely ask parents about violence in the lives of children. Providing a comprehensive medical home – one that is family-centered, coordinates care effectively, and is accessible – is key to effectively addressing the issue of exposure to violence with children and adolescents. Resources are available through the National Center for Medical Home Implementation to help pediatricians do just that. The medical home plays a critical role in identifying children and adolescents who have been exposed to violence and coordinating the referral and follow up for needed services.

Starting the Discussion about Exposure to Violence

Beginning the conversation with a family or patient regarding exposure to violence can be difficult. Pediatricians may worry that families will be offended or wonder why they are being asked the question. Establishing the context and expressing general concern reassures families that they are not being singled out for these questions. One approach might be saying "We hear so much about violence these days that I have begun to talk to all of my families about exposure to violence." Pediatrician Nadine Burke Harris, MD, MPH, FAAP uses these 4 questions:

Are there any behavior problems with the child at home and/or school?

Has anyone come or gone from the household lately?

Are there any problems with sleep and enuresis?

Has your child ever witnessed anyone being harmed at home or in the community?

The pediatrician’s interest in the topic gives an important message to parents and children:

Exposure to violence is a health issue

It’s okay to talk about the issue with the doctor

There are resources available to help

How to Use These Resources

While the types of violence that exist are numerous, the information below addresses those issues most often discussed in the pediatric medical home setting. In no way are these resources exhaustive. Instead, they are meant to provide a starting place for the pediatrician and the medical home team to begin addressing exposure to violence with their patients and families.

The resources are laid out in a consistent pattern for each type of violence. For each topic, you will find:

Framing the Question: Some very basic starter questions to help you begin the conversation about the particular topic with the patient or family. Depending on the situation, the questions will be directed toward the parent, while in others they are directed toward the child or adolescent.

Actions to Take: Provides some possible next steps if it is determined the child has been exposed to that particular type of violence. Again, this is not an exhaustive list of possible actions, but just key things to consider.

Tools to Educate: Provides links to resources that can be provided to educate parents or children on that particular topic.

Learn More: Provides links to Webinars (recorded) and videos that educate and demonstrate to the pediatrician and medical home team how a variety of issues can be addressed during the patient visit.

Additional Tools: For brevity, there are a small number of tools referenced on each page. There are numerous resources, however, from a variety of excellent organizations that address the issue of exposure to violence. A number of these additional resources are listed here, broken down by types of tools and the audience for which they are intended. Let us know if you would like to suggest one.

If there are issues not addressed on this site related to exposure to violence, please contact AAP staff atmhcev@aap.org and we will do our best to help get you the information you need.